novelnext Chapter 137 Preoperative Discussion!
Chapter 137 Preoperative Discussion!
Chapter 137 Preoperative Discussion!
Yishi, 6:20 PM.
The red glow of the setting sun illuminates a corner of the trauma surgery department at Yilan Central Hospital.
The hospital building faces south, and the setting sun shines obliquely in, casting pale red beams of light onto the walls and scattering in all directions.
The oval table was already full of people.
Zeng Yaqiong tapped the table with the index and middle fingers of his left hand as he said, "Professor Min, you've done a very good job with the logistical support."
"We can have dinner first, then get together and chat."
Min Chong knew that Zeng Yaqiong was implying that Guo Ziyuan was late: "Dr. Guo is currently working in the emergency department's operating room and could only come here after a certain time."
"He's already off work and on his way. Please be patient."
Zeng Yaqiong nodded, her tone relaxed: "That's incredibly busy, you don't even have time on weekends."
As Zeng Yaqiong was speaking, there was a knock on the office door.
A young man wearing a white coat, a name tag, and a disposable surgical mask appeared at the door.
When he reached the door, his expression stiffened for about three seconds before he walked in as if nothing had happened: "Excuse me for disturbing you teachers. Please continue, I'll just sit in."
Seeing Guo Ziyuan preparing to walk towards the standing crowd, Min Chong immediately stood up and went forward to greet him: "Dr. Guo, please come and sit here."
Everyone is waiting for you.
Guo Ziyuan slightly raised his eyelids: "Professor Min, I'm here today as an auditor—"
"Stop gossiping, sit down first." Min Chong led Guo Ziyuan to sit next to him.
Then she began to introduce the people to Guo Ziyuan: "Dr. Guo, this is Professor Zeng Yaqiong, whom you met during our video conference before."
"This is Professor Dong Hongmin from the Department of Trauma Surgery at Tongji Hospital—this is Professor Cao Ling from the Department of Interventional Radiology at Union Hospital—"
Min Chong introduced five people to Guo Ziyuan before finally introducing Guo Ziyuan to them.
Besides Zeng Yaqiong and others, Liu Hanjun and others from the Department of Trauma Surgery also focused their attention on Guo Ziyuan.
But it seemed that Guo Ziyuan was only nervous, not stage-frightened: "Greetings, teachers. I am Guo Ziyuan, a student from Hubei Provincial People's Hospital."
"Professor Min, where are we in the discussion? Please continue leading; I'm just here to observe."
Zeng Yaqiong said in a somewhat hesitant tone, "We've said everything we needed to say, now we're just waiting for you, the one who's going to be here."
"Everyone's been waiting for you here, Dr. Guo."
Zeng Yaqiong's tone was obviously accusatory. He had come all the way from Kyoto, and he didn't believe that Guo Ziyuan couldn't even ask for a weekend off.
"Professor Min, why don't you give me a hint? Give me a starting point?" Guo Ziyuan, of course, had no idea how far the conversation had progressed, so he simply asked directly.
A glint flashed in Zeng Yaqiong's eyes, but he quickly concealed it.
The reason he took the initiative on the spot was actually to use his words to discourage the other people who did not know Guo Ziyuan!
In important occasions, unless someone is extremely familiar with you, they are more likely to come out and symbolically cause you some trouble in order to give everyone a way out.
However, Guo Ziyuan did not delve into this point, which shows that Guo Ziyuan's psychological qualities are extraordinary.
Those with the demeanor of a great general do not concern themselves with trivial matters.
Min Chong then said, "Dr. Guo, we have finished discussing the specific diagnosis and local microcirculation. What we are discussing now is how to use interventional methods to visualize the local microcirculation."
"According to Professor Cao Ling from the Interventional Radiology Department, if we really want to be able to confirm with the naked eye that the drug has entered the bloodstream, then..."
"It is best to add contrast agent to the infused medication for visualization, as this will provide a more direct and visual result."
"I wonder what Dr. Guo means?"
Min Chong had, of course, invited Guo Ziyuan in advance and hoped that Guo Ziyuan could take a leave of absence.
However, Guo Ziyuan seemed to have a strong personality; he said that it was okay to attend the preoperative discussion, but only after his get off work hours.
It was as if Guo Ziyuan coveted a treasure in the control room. Min Chong offered to ask Guo Ziyuan for leave, but Guo Ziyuan refused.
"I think Professor Cao's suggestion is reasonable, but we must determine two points before we proceed."
"First, whether sensitive and effective antibiotics can coexist with contrast agents needs to be confirmed to ensure there are no drug interactions."
"Secondly, when administering contrast agent locally, is it necessary to apply small amounts multiple times, or is it necessary to apply contrast agent with each application?"
Upon hearing this, Professor Cao Ling of Peking Union Medical College Hospital frowned slightly: "Judging from Dr. Guo's words, it seems that he doesn't want to use contrast agents for tracing?"
"What if the medication doesn't reach the microcirculation if it's not tracked?"
Guo Ziyuan nodded slightly: "Professor Cao, this is what I'm thinking. If it doesn't go in the first time, then we can try again the second time."
"Even if sensitive antibiotics are not administered into the local microcirculation, they can still be administered into the local soft tissues."
"Our current accepted diagnosis is that the patient has osteomyelitis, and the original bacterial flora is in the microcirculation of a special connected structure."
"This does not mean that there are no bacteria residing in the soft tissues outside the microcirculation!"
"The procedure of puncture and drug administration is not a critical, one-off operation; it is not a situation where once it is performed, there will be no next opportunity."
"If I really had to give advice, I would say that injecting contrast agent locally to confirm that the contrast agent has entered the circulation would be evidence that the puncture into the blood vessel was effective."
"Contrast agents and antibiotics cannot be carried together."
"The contrast agent has leaked, and I don't know what bad consequences might occur."
"But what is certain is that topical antibiotics will still have a therapeutic effect even if they leak into the surrounding soft tissue."
Cao Ling's perspective differed from Guo Ziyuan's: "Is Dr. Guo really that confident?"
Are you sure you can insert the puncture into the microcirculatory blood vessel in one go?
In interventional radiology, vascular punctures are generally performed on large and medium-sized blood vessels; punctures on small blood vessels are quite rare.
Interventional procedures are a means of imaging and observation, as well as a treatment method; this is Cao Ling's specialty.
However, he had never dared to consider performing a puncture on a local microcirculation.
Guo Ziyuan shook his head: "Professor Cao, on the contrary, I feel that my chances of a successful puncture on the first try are not high."
"Therefore, it is necessary to increase the chances of success by accumulating quantity."
"According to the principles of antibiotic administration, small doses should be given frequently."
"So, in principle, the medication needs to be administered daily, which creates many opportunities for punctures —"
"Local puncture is less invasive. If the puncture is proven effective initially, we can leave an opening untreated."
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"As we become more proficient, we can complete the procedure without entering the operating room."
"Professor Cao, bone marrow aspiration and spinal cord puncture are both performed at the bedside, right?"
Upon hearing this, Cao Ling became slightly annoyed: "Since that's what Dr. Guo thinks, why did you call me over?"
Guo Ziyuan instinctively looked at Min Chong and the others, saying that they were making a big fuss over nothing.
"Professor Cao, please don't be angry. This is the preoperative discussion stage, so everyone has their own opinion and can speak freely."
"Finally, we'll come up with a treatment plan that everyone agrees is feasible."
"If you're just sticking to your own ideas, then whether I come to this discussion or not is meaningless."
Cao Ling is a doctor in the interventional radiology department.
The full name of the interventional department is the Radiological Interventional Department.
Therefore, Cao Ling's expertise is the best match for Chi Huanlin's surgical skills.
Cao Ling was the one among them who understood Guo Ziyuan's proposed treatment most deeply.
Cao Ling wasn't there to throw a tantrum: "Dr. Guo, okay, let's not discuss the treatment medication and imaging for now."
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"Dr. Guo, what do you plan to rely on for imaging during the puncture procedure?"
Whether it's interventional radiology or anesthesiology, precise local punctures must be performed under ultrasound, CT, or MRI imaging guidance.
According to the basic theory of puncture, you can only puncture the target area if you know where the target is.
Guo Ziyuan shook his head: "Professor Cao, I've also considered many forms of imaging intervention, but I still haven't found a suitable one."
"The blood vessels in the local microcirculation within the bone marrow are too small to be visualized."
"If it is a blood vessel that nourishes the bone, it can be continuously visualized using MRI."
"But this won't do."
Professor Cao Ling, with his large, bulging eyes, asked, "So you're planning to skip monitoring the operation?"
Guo Ziyuan was not intimidated: "It's not that I don't want to monitor, it's that I don't have the conditions or the right methods."
"Professor Cao Ling, I really hope you can suggest a method that can provide intuitive guidance!"
Guo Ziyuan threw the question back at him with a specific one, and even made a very serious "please speak" gesture.
Cao Ling fell silent.
He couldn't give it to him.
Given the current level of technology, there is nothing that can locate and visualize the blood vessels in the microcirculation within the bone marrow.
If the contrast agent can effectively visualize the whole body, then there is no problem with the connection between the microcirculation and the whole body's blood supply, and the drug can be administered directly intravenously.
This is an established fact regarding the basic anatomy of an individual.
Seeing that Cao Ling remained silent, a middle-aged man with a slightly chubby face, nose, chin, neck, and overall build, and with slightly chubby small hands, said, "Dr. Guo, have you considered that the most direct and effective treatment for this situation is local osteotomy?"
Although it was the first time that Guo Ziyuan had met Professor Dong Hongmin so closely face to face.
Guo Ziyuan, both in his past life and in the present, has seen Professor Dong Hongmin give his opinions at various academic conferences on numerous occasions.
Professor Dong Hongmin of the Department of Trauma Surgery at Tongji Hospital has an average appearance; he looks like an ordinary, overweight man.
But anyone who dares to underestimate him, even a professor at Jishuitan Hospital, can be fooled by his appearance to the point of ecstasy.
Even top-tier orthopedic hospitals like Jishuitan Hospital and Shanghai Sixth People's Hospital wouldn't dare to "show off" in front of Dong Hongmin.
They said Dong Hongmin's skills were just so-so.
People like Dong Hongmin have a private nickname across the country: "national champion".
"Professor Dong, I also think this surgery is the best solution."
"Bone transport via local osteotomy combined with external fixation rings is the simplest and most effective method."
"But after thinking about it carefully, I felt that there might be another problem."
"The blood supply to the patient's bones is less connected to the systemic blood supply, so if we perform a bone resection..."
"Bone growth requires blood supply and nutrients. If the local blood supply and nutrients are insufficient, the rate of bone growth will slow down."
"The treatment is effective, but the treatment period may be longer."
"At that time, if we want to avoid delayed healing or non-healing of the fracture, we may still need to treat the local area."
"I wonder if Professor Dong feels the same way?"
Upon hearing this, Dong Hongmin sighed: "That's exactly what I considered, which is why I didn't stick to the surgical approach of directly cutting the bone."
"No wonder she has princess bones."
Min Chong did not hold a grudge. Dong Hongmin described Chi Huanlin's skeletal structure in this way.
It's not bad, it's just hard to heal and has a bad temper.
Dong Hongmin said, "Then let's do as Dr. Guo says."
"Professor Cao, Professor Xue, and Professor Ling, I'd like to mention them here again."
"Xiao Guo is from our trauma surgery department. Our trauma surgery department may not be as detailed as your specialties such as hand surgery, interventional surgery, and minimally invasive surgery."
"We never care about hitting the bullseye on the first try."
"In our trauma surgery department, there are often cases where multiple surgeries are required."
"Therefore, everyone should not be too demanding of Dr. Guo that the procedure must be effective on the first try."
"The approach is sound, and the surgery won't be too invasive, so we can give it a few more chances to try."
Min Chong looked around and asked, "Professor Ling, do you have any further comments?"
Ling Guoan is a professor of minimally invasive surgery. He came here simply to make up the numbers: "Professor Min, I'll listen to everyone's opinions."
"Even our minimally invasive surgery team has never performed this kind of surgery before." Ling Guoan smiled slightly, his eyes looking at Guo Ziyuan with curiosity and disbelief.
He now feels that the phrase "young and promising" has become a tangible reality in Guo Ziyuan.
"Then it's settled. The surgery will be tomorrow, the 7th."
"Dr. Guo, I'll have to trouble you to take a day off then." Min Chong understood and appreciated Guo Ziyuan's perspective.
Guo Ziyuan is a proper trauma surgeon. His path lies in trauma surgery. With such a good foundation, it would be a waste for him not to practice his basic skills in the operating room.
Without this support, if Guo Ziyuan still dares to act arrogantly, he would be the first to disagree.
No sooner had Min Chong finished speaking than Zeng Yaqiong, who had initially been angry with Guo Ziyuan, immediately said, "Dr. Guo, let's have a private talk after the discussion."
Zeng Yaqiong's words made the others hesitate to speak.
Guo Ziyuan was taken away by Zeng Yaqiong, and he probably won't be able to stay idle for a while.
Then they wouldn't have time to talk to Guo Ziyuan anymore.
Guo Ziyuan nodded: "Professor Zeng, I need to have some food first."
Min Chong quickly turned his head and whispered, "Dr. Guo, I know, the food has arrived."
"It just wasn't the right time to give it to you."
After saying that, Min Chong stood up: "Professor Dong, Professor Cao, Professor Xue, let me take you back to your hotel to rest first."
"Okay!" Dong Hongmin was the first to stand up.
"Xiao Guo, you need to get a good rest tonight so you can have plenty of energy."
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